International Circulation: For permanent atrial fibrillation， which kind of treatment do you prefer between catheter ablation and drug treatment?

　　《国际循环》：对于永久性房颤，在药物治疗和消融治疗之间您更倾向于哪种治疗?在您的国家永久性房颤消融治疗的成功率是多少?

　　Roberto De Ponti: It depends on the patient. I would say that permanent (which is the wrong term because long-lasting persistent atrial fibrillation should be used) is a very comprehensive term. It means that in this kind of pot you can find a lot of patients. You can find patients with a left atrium larger than 55mm in diameter whereas some other patients can also be found. We have a series of patients with a relatively small left atrium with a permanent or long-lasting persistent atrial fibrillation who could be cured only by isolation of the pulmonary vein. These are patients younger in age， usually less than 60， with very fast activity from the pulmonary veins. If you cardiovert these patients， you find a very early recurrence of atrial fibrillation because of the very fast activity from the pulmonary veins. We found that only pulmonary vein isolation in these patients was able to achieve good control of the arrhythmia. No complex ablation procedure was needed. For these patients， I would advise to go towards an ablation strategy rather than having a life-longdrug therapy. In other patients with large and dilated left atria， more than 55mm in diameter， with a relevant structural heart disease， I would consider a drug strategy first rather than doing ablation.